How is the American Diabetes Association Working for Women?
According to the American Diabetes Association (ADA), almost 30 million children and adults in the U.S. have diabetes, and 86 million Americans have pre-diabetes. The cost and complications are high, and the numbers are only skyrocketing. If current trends continue, as many as one in three American adults will have diabetes by 2050.
WomensHealth spoke with the non-profit organization, which helps fight diabetes through research, advocacy, and support. What are the latest research and developments from 2016, and what’s ahead in 2017?
WomensHealth.com: Tell us about 2016. What research is the ADA excited about?
American Diabetes Association: During its 76th year, the American Diabetes Association continued its commitment to its mission—to prevent and cure diabetes and to improve the lives of all people affected by diabetes. We understand the impact of diabetes on so many Americans, and the need to support increased innovation and research advances that can lead to improved health outcomes and quality of life for all people affected by diabetes.
In 2016 alone, the Association made more than $34.5 million available for research. These funds supported 378 new and continuing research projects performed by 351 investigators at 150 leading academic research institutions across the U.S. Association-supported researchers contributed to improved understanding of how diabetes develops and progresses, and helped identify new prospects for combating the disease and its complications.
The 2017 Standards of Medical Care in Diabetes, the national and international benchmark for quality health care for people with diabetes and their health care providers produced annually by the Association, includes a number of new recommendations based on research from around the world. Some of the updates for women include:
- Postpartum testing for women who had gestational diabetes during pregnancy to ensure their diabetes has not continued after giving birth. These tests are now recommended for between four and 12 weeks postpartum. This change allows test results to be discussed at the standard six-week postpartum checkup, or allow for the test to be rescheduled during that visit if the test has not yet been completed.
- For managing diabetes during pregnancy, insulin is emphasized as the treatment of choice because of concerns about other medications that may affect the fetus.
- Health care providers are encouraged to discuss the increased risk of retinopathy for women with pre-existing type 1 and type 2 diabetes who are planning to become or are pregnant.
WH: What new therapies or drugs are available that our readers should know about?
ADA: In September, the Association applauded the Food and Drug Administration (FDA) approval of the first-ever hybrid insulin delivery system—a critical step toward the development of an artificial pancreas, which would help people with type 1 diabetes better manage their care. The new device automatically adjusts basal insulin levels based on glucose readings from an integrated continuous glucose monitor. While daily finger-stick checks would still be needed for calibration of the device, the device would replace the normal testing and self-administration of insulin for anyone who is currently using or is a good candidate for an insulin pump.
WH: What continue to be the biggest challenges to those working in the field of diabetes?
ADA: While there have been many advances in treatment and understanding of diabetes, those efforts are wasted if people with diabetes can’t afford the medications they need to stay healthy and manage the disease. Confirmed by a recent study in the Journal of the American Medical Association, the cost of insulin nearly tripled between 2002 and 2013—meaning millions of Americans with diabetes are paying a steep price to stay alive. Combined with the potential for significant changes to the nation’s health care system as the newly elected federal administration and Congress consider replacing the Affordable Care Act, one of the greatest challenges moving forward will be to ensure that people with diabetes can afford the care and medications they need.
In November, the Association announced a resolution and the launch of a petition calling on all entities in the insulin supply chain to increase transparency and to ensure that no person with diabetes is denied affordable access to insulin. The Association is also calling on Congress to hold hearings with all entities in the insulin supply chain to identify the reasons for the dramatic increases in insulin prices and to take action to ensure affordable access to insulin for all who need it.
The Association remains committed to ensuring that the millions of Americans with diabetes have access to affordable, quality health care and affordable diabetes medications.
WH: What support is available to individuals and families who are living with diabetes?
ADA: Diabetes.org, the Association’s website, offers educational resources, meal ideas, information about treatment and care and more. The Association’s Center for Information call center, 1-800-DIABETES, can also provide people with diabetes and their families with diabetes resources.
For assistance with the cost of medications, including insulin, there are prescription assistance programs available. Visit http://www.diabetes.org/living-with-diabetes/health-insurance/prescription-assistance.html for more information.
WH: What goals does the ADA have for 2017?
ADA: In 2017, the Association will continue its dedication to research, support and education for all people with and affected by diabetes and the health professionals who help them manage their care. As the leading source of information about diabetes care and management, the Association is committed to ensuring that advances in care are available to people with diabetes and their health care providers.
The Association’s Chief Scientific & Medical Officer Robert E. Ratner, MD, retired at the end of 2016 after nearly five years of stellar service, and we are proud to welcome William T. Cefalu, MD, as his successor. Dr. Cefalu joins the Association on February 20, 2017, from LSU’s Pennington Biomedical Research Center in Baton Rouge with more than 30 years of work in diabetes research and care. We look forward to Dr. Cefalu’s expertise and perspective in helping us to strengthen and enhance the Association’s diverse programs and services for diabetes health care providers and people with diabetes.
The Association is also poised to fight for the advancements made by the Affordable Care Act, urging leaders to immediately follow any repeal of the ACA with a replacement that ensures vital health care coverage for people with diabetes, especially critical protections for pre-existing conditions, and affordable access to insulin and other diabetes medications.
WH: What areas of research is your association excited about for the future?
ADA: Diabetes and women’s health intersect in many areas, including pregnancy, transgenerational disease risk and heart disease risk.
About nine percent of pregnant women in the U.S. are diagnosed with gestational diabetes—a form of diabetes that usually goes away after the baby is born. Gestational diabetes increases the risks for large birth weight, birth complications and later development of type 2 diabetes in both the mother and the child.
Children exposed to any type of diabetes while in the womb are 10 times more likely to develop type 2 diabetes and obesity than those who are not exposed. This is considered a transgenerational risk associated with the in utero environment.
Furthermore, while premenopausal women without diabetes have lower risk of heart disease than men of the same age, premenopausal women with type 1 diabetes have a heart disease risk equal to men.
Interesting discoveries in these areas are shaping the future of care. For example, American Diabetes Association Pathway to Stop Diabetes awardee Marie-France Hivert, MD, of Harvard Medical School, has discovered that gestational diabetes is not a uniform disease. It differs from one woman to another, and the different causes lead to different outcomes for women and their children. In her continuing studies, Dr. Hivert will be studying how genetics are linked to the subtypes of gestational diabetes. With this information, health care providers may begin to target more intensive treatments to the women and children who are at high risk for complications during or after pregnancy.
Association-funded researcher Maureen Charron, PhD, at Albert Einstein College of Medicine, has found that a high-fat diet during pregnancy and lactation in mice causes offspring to be more susceptible to the negative effects of a high-fat diet later in adulthood. Now, Dr. Charron is studying humans to determine if air pollution exposure in the womb changes how genes function and if these changes impact the risk for diabetes or obesity in the children.
Janet K. Snell-Bergeon, MPH, PhD, of the University of Colorado Anschutz Medical Campus, has found that insulin resistance, a characteristic historically associated with type 2 diabetes, is significant in young women with type 1 diabetes, and she believes this insulin resistance is key to the increased cardiovascular risk present in type 1 diabetes. With an American Diabetes Association career development grant, Dr. Snell-Bergeon aims to determine how.
New discoveries in early-stage and innovative research projects supported by the American Diabetes Association are laying the groundwork for improving diabetes-related health outcomes for women and children.
WH: What would you like readers to know about the ADA that you haven’t addressed?
ADA: Founded in 1940, the Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes.
The Journal of the American Medical Association: Expenditures and Prices of Antihyperglycemic Medications in the United States: 2002-2013; April 5, 2016; http://jamanetwork.com/journals/jama/fullarticle/2510902